A 51 year old male without known medical history presents to the emergency room with upper GI bleeding. Emergent endoscopy reveals isolated gastric varices, which are injected with sclerosant successfully.
Gastric varices often occur in the setting of cirrhosis and portal hypertension, but in the absence of liver disease, an alternative explanation should be sought. Gastric varices, or left sided portal hypertension, can occur in the setting of a splenic vein thrombosis. Splenic vein thromboses can be seen after cases of acute pancreatitis or in thrombophilic states.
In the image below, the splenic vein can be seen traversing the abdomen, from the hepatic hilum on the patient’s right side to the spleen on the left. The thrombus is seen as a dark, serpentine-like filling defect in the vessel lumen.